The MAO must successfully complete annual QI projects that focus on both clinical and non-clinical areas and submit the project reports to the evaluation entity. 

The Basics

The URAC standard that supports QY09, MAP-QIP 1, requires that your organization's quality improvement projects (QIPs)involve performance measurement based on valid and reliable data, system interventions, demonstrable performance improvement, and study of the impact the interventions had on performance.  The QIP's quality indicators need to be based on current health research and be capable of measuring outcomes.  Examples of outcomes include health status changes, enrollee satisfaction, or similar measures.  The organization must report QIP status and results to the quality management committee.

Management Tips

An MA health plan, unlike URAC health plans that are not MA plans, must have QIPs that actually work.  It is not merely enough to implement interventions that should work.  Rather, they must work.  So, this is not the venue to try out interventions with uncertain results.  

URAC Accreditation Tips

For the desktop review you'll want to submit the same documents that you submitted for the previous standard.  Similarly, the process described for the onsite review in the previous standard applies to this standard, as well.